During the 1960's and through the 1970's the UMWA Health and Retirement Funds sponsored and supported the development of ambulatory clinics for their beneficiaries in the coalfields of West Virginia. Through June 1977, Union members were provided one of the most comprehensive health benefit plans. On July 1, the Funds retrenched the financially overextended Funds program by imposing a 40% copayment for medical services and by discontinuing the retainer system. This reverted to a fee-for-service payment program. After a four-month coal strike when no coverage was available, the Union settled for an industry-backed package of benefits provided through commercial carriers. The objective of this proposal is to examine the impact and consequences of recent changes in miner health care coverage in the 14 West Virginia primary and multi-specialty clinics that had greater than 30% Funds beneficiary participation as of July 1976. The study will be examined during four time periods: 1) the baseline year - July 1976 to June 1977; 2) the copayment period - July 1977 to December 1977; 3) the strike period - December 1977 to March 1978; and 4) the stabilization period - April 1978 to December 1978. The major topics to be addressed at each clinic include: 1) changes in caseload; 2) availability of providers; 3) scope and mix of services; 4) administrative decisions and 5) financial considerations. The first section examines the extent that changes occurred in total clinic and Funds beneficiary use of clinic service during the months when health coverage varied as compared to baseline levels. The second section considers the availability of medical staff, midlevel practitioners, and nursing staff in the baseline year and at the close of the study period, following the retrenchment of the Fund retainer and modification of the miner's health insurance. The third section examines the scope and mix of services offered in the baseline year when Funds financial backing and support promote a broad scope of services, as compared to the close of the study period when alternative sources and levels of funding were obtained and levels of services were adjusted accordingly. The last two sections address factors which influenced changes in internal clinic operations and financial measures taken to assure continued provisio (Text Truncated - Exceeds Capacity)